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    Viibryd

    Drug - Viibryd (vilazodone) [Forest]

    February 2013

    Therapeutic area - Antidepressant

    Approval criteria

    • Patient is 18 years of age or older AND
    • Patient has a diagnosis of major depressive disorder AND
    • Patient has tried and failed two separate 2 month trials of 2 preferred SSRIs AND
    • Patient has a documented intolerance/contraindication to OR has tried and failed a 2 month trial of 1 other preferred new generation antidepressant (i.e. venlafaxine, bupropion, mirtazapine or a tri-cyclic antidepressant)

    Selective Serotonin Reuptake Inhibitors

    Preferred Nonpreferred
    citalopram
    escitalopram    		 Celexa
    fluoxetine Lexapro
    Paxil/Paxil CR
    paroxetine Prozac
    Pexeva Fluoxetine DR (weekly)
    Prozac Weekly
    sertraline paroxetine suspension
    Sarafem
    Viibryd *
    Zoloft
    * individual PA criteria apply

    New Generation Antidepressants

    Preferred Nonpreferred
    bupropion IR, SA, XL Aplenzin* (bupropion HBr)
    fluvoxamine Cymbalta
    mirtazapine Desyrel
    nefazodone Effexor, Effexor XR
    trazodone Luvox CR *
    venlafaxine extended release Prestiq *
    venlafaxine extend release capsules (generic EffexorXR) Remeron
    venlafaxine extended release Wellbutrin/ SR / XL
    tablets (generic)
    * individual PA criteria apply

    Quantity limits

    Metabolism by CYP3A4 is a major elimination pathway for vilazodone. Patients must start Viibryd using the Patient Starter Kit or the 40 mg dose. If the prescriber is requesting 10 mg or 20 mg strengths, documentation that Viibryd is being used for maintenance therapy and is being co-administered with a strong inhibitor of CYP3A4. 

    • Quantity Limit = 34 (all strengths)

    Background information

    Viibryd (vilazodone) is a selective serotonin reuptake inhibitor (SSRI) and a serotonin (5-HT1A) receptor partial agonist indicated for the treatment of major depressive disorder (MDD) in adults. Vilazodone is titrated to the recommended dose of 40 mg once daily with food. There are many other drugs indicated in the initial treatment of MDD including: tricyclic antidepressants (TCAs), SSRIs, SNRIs, bupropion and mirtazapine.

    Rationale

    The most recent guidelines published by Kaiser Permanente Care Management Institute in 2006 for the treatment of depression in primary care recommend SSRIs, TCAs, serotonin norepinephrine reuptake inhibitors SNRIs, and dopamine agonists as first-line treatment of MDD. The preference of antidepressant is based on patient’s history with drug treatment, clinician choice, adverse effects, among other factors. Vilazodone is the first FDA approved antidepressant with a dual serotonergic mechanism of action acting as both a SSRI and a partial serotonergic agonist. There are no clinical trials comparing the efficacy or safety of vilazodone to other antidepressants. It is not clear if vilazodone offers any unique efficacy or safety advantage over existing therapies.

    Questions?

    MHCP Provider Call Center 651-431-2700 or 800-366-5411

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